Intensive care needs and short-term outcome of Multisystem Inflammatory Syndrome in Children (MIS-C): Experience from North India

Abstract

Objectives

To describe the intensive care needs and outcome of Multisystem Inflammatory Syndrome in Children (MIS-C).

Methodology

This retrospective study was conducted in the Pediatric Emergency and Intensive Care Units and COVID-19 hospital of a tertiary care teaching and referral hospital in North India over a period of 5 months (September 2020-January 2021). Clinical details, laboratory investigations, intensive care needs, treatment, and short-term outcome were recorded.

Results

Forty children with median (IQR) age of 7 (5-10) years were enrolled. The common clinical features were fever (97.5%), mucocutaneous involvement (80%), abdominal (72.5%) and respiratory (50%) symptoms. Shock was noted in 80% children. Most cases (85%) required PICU admission where they received nasal prong oxygen (40%), non-invasive (22.5%) and invasive (22.5%) ventilation, and vasoactive drug support (72.5%). The confirmation of SARS-CoV-2 exposure was noted in the form of positive serology (66.7%), RT PCR (10%), and contact with SARS-CoV-2 positive case (12.5%). The common echocardiographic findings included myocardial dysfunction (ejection fraction <55%) (72.5%), and coronary artery dilatation or aneurysm (22.5%). The immunomodulatory treatment included IVIG (2 gm/kg) (100%) and steroids (methylprednisolone 10-30 mg/kg/day for 3-5 days) (85%). Aspirin was used in 80% and heparin (low molecular weight) in 7.5% cases. Two children died (5%) and median duration of PICU and hospital stay in survivors were 5 (2-8) and 7 (4-9) days, respectively. Children with shock showed higher total leucocyte count and higher rates of myocardial dysfunction.

Conclusion

Cardiovascular involvement and shock are predominant features in severe disease. Early diagnosis may be challenging given the overlapping features with other diagnoses. A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, GI and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection. The short-term outcome is good with appropriate organ support therapies and immunomodulation.